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FOR SERVICE CALL: • SERVICE ORDER • <br /> PARLIER ASBURY ENVIRONMENTAL SERVICES, DBA FORM NO.WOE5004-D (1/17) <br /> 559-498-0240 <br /> O SERVICE ORDER N0. <br /> FOR ACCOUNTING CALL: <br /> 562-231-1550 <br /> WORLD OIL <br /> ENVIRONMENTAL SERVICES. <br /> S <br /> H 14287 EAST MANNING AVE,PARLIER CA 93648 <br /> 1-559-498-0240 <br /> p <br /> [ WWW.WORLDOILCORP.COM <br /> 0 <br /> T TRANSPORTER EPA k CAD028277036 <br /> 0 <br /> CUSTOMER# PURCHASE ORDER IF ROUTE# TRUCK# CONTACT NAME ORDER TAKEN BY HALIDES <br /> DATE REQUIRED DATCENTCRED NEXT SERVICE DATE CUSTOMER EPA# BILL of LADINGiMANIFESTm <br /> DESCRIPTION QTY U ' <br /> TOTAL <br /> CASH RECD: CHECK# <br /> WASTE DISPOSAL INFORMATION <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(USED OIUMIXED OILS) STATE CODE 221 <br /> NON-RCRA HAZARDOUS WASTE,LIQUID(ETHYLENE GLYCOL SOLUTIONS) STATE CODE <br /> OTHER: <br /> DESIGNATED TSDF:_ <br /> ALTERNATETSDF: <br /> DRUMSP/U:___ EMPTY DRUMS: FACILITY: BSC <br /> GENERATOR WASTE CERTIFICATION(PLEASE CHECK THE APPROPRIATE BOX) <br /> By pgnaig Mow I hereby certify that: <br /> (Waste oil generator/customer MUST check ONE of the following three boxes) <br /> Oa <br /> 1)1 have not miwt any ohne waste desmbed abeve wlm any other,hazardous waste,the total raise come,n.EsS than t Uoo ppm,and the waste din not contain any KIK I haae canplled with the repuiremems rt <br /> lite applia hh Cahlornia used oil managertrerst regulahor¢to dreenn n,this is One.1 agree to accost tire additional chil for the dlspusal of this wane If the mfotmatlon I have prpdded about IMs waste n InceKt <br /> 0+21 have not mind any of the waste described above with any cohn haardnus wane,the total halide Inman,is GREATER than I.000 in and the waste does not con,nn any KBs.I <br /> have stovded proper dorutslentation m World Oil Emironmel Servkes W reWt W prshuggeon that MIs wastewas miaed ywth mho hazardous wase I agree to accept the addhianal charges Jocose higa sal ra this <br /> waste dthe inf.Or.I have prpadM about thiswasa Is incorrect <br /> EZIaBt This waste is from a tank which cNkrcos waste of hom househoW'da tt-yourxN'(INYI aIN/a casditimralyeaempt stroll qudnmV 9enerata ICES(IGl sources.To the hest Mmy kcwwk lege,d.only waste ou conarrred <br /> my MY'aW cdecra s lank is coley f1.1 oy andmt CE5M..as.I have dor nswed th@ wagis oil wim aly other huardous wane or waste nil from other coo,es l agrw Io arrMr the adtlitinna charges far drspoa' <br /> M the waste d the information I nave ryowded about this wage is incorrect <br /> (All generators/customers MUST read the following text and check the associated box.) <br /> E=144I If I am a large quantity gn srator,I certify that I have a program in 0.a to 1"hi the volume and tonicity of waste generated to the degrce I have de ennewsl to M nonninnally prarn,ank and that 1 have <br /> Selena the prachabe henhod of heatment st01 or Msposa r.urrentty avaslade to me whir rniami>es the present and Forest,threat to human Ile and ma environment'or#1 am a small quantity ,,a,.,I <br /> have made agood hath e#mt to tMnrala <br /> .nor by wash genes nt seer,Me ben wane management method diavailable to ore that Ivan afford. <br /> Thr.IAdiwdual slgni,{in the Wate set forth beimv he isrhetf of(i nom.mprasents am.,an,,that he/she has Ilya authority to bind Cuaamer,that the forgoing clognptlom of waste and matnuh are One and.xcuram <br /> a1 ph.k1w1 marked and lalsoed.am ready for mnepnwtion In accordance with aWlaan,nae and Federal r huehom.and that Covmmer mall abide and be bourW In,the Slandand Tern and C nrMXmn,on the reverse <br /> )kir'of I h" nyw.(AMr <br /> Customer Signature Date r , Driver Signature Date <br /> Print Name Print Drivers Name <br />